Palpation Study Guide
Palpation Study Guide
deltoid (ANT)
deltoid (middle)
deltoid (POST)
supraspinatus
infraspinatus
teres minor
teres major
subscapularis
long head of biceps
short head of biceps
coracobrachialis
long head of triceps
DISTAL HUMERUS
MED epicondyle
MED supracondylar line
LAT epicondyle
LAT supracondylar line
trochlea
olecranon fossa
coronoid fossa (**)
capitulum (**)
FOREARM
olecranon process
head of radius
shaft of radius
styloid process of radius
head of ulna
shaft of ulna
styloid process of ulna
olecranon fossa
coronoid process (**)
MUSCULAR / NERVOUS structures
radial nerve (in spiral groove of humerus)
ulnar nerve (behind medial epicondyle)
brachial artery (in upper arm and cubital fossa)
median nerve (in cubital fossa)
MUSCLES - wrist FLX & PRON
pronator teres
flexor carpi radialis (distal tendon)
palmaris longus (distal tendon)
MUSCLES - wrist EXT
extensor carpi radialis longus (distal tendon)
extensor carpi radialis brevis (distal tendon)
MUSCLES
brachialis
brachioradialis
TENDONS / LIGAMENTS / BURSA
biceps tendon
triceps tendon
MCL (medial collateral ligament)
LCL (lateral collateral ligament)
annular ligament
olecranon bursa (**)
obvious
obvious
put arm behind the back
put arm behind the back
move posteriorly and medially from acromion
medial side @ level of T3
point of shoulder … follow clavicle out to AC joint
deepest portion of clavicular concavity, 1 inch from anterior edge of clavicle, press laterally and posteriorly, deep to pec major
know on skeleton (supraspinatus lies in this space)
know on skeleton (infraspinatus lies in this space)
know on skeleton (subcapularis lies in this space)
in spiral groove of humerus between flexor and extensor compartments of arm approx. in upper 1/3 of humerus
between medial epicondyle and olecranon process, feels soft round and tubular. "groove" of medial epicondyle
medial to biceps tendon
medial to brachial artery
have pt make fist as offer resistance to dorsum of hand, wrist extension, proximal to 2nd and 3rd metacarpal, palpate proxima
same as longus
close fist in supination under edge of table and try to lift table
goes into olecranon process
fan shaped, from medial epicondyle to medial margin of ulnar trochlear notch, not directly palpable (check for tenderness)
rope like structure from lateral epicondyle to side of annular ligament
cups radial head and neck
covers olecranon bursa, thin at apex of olecranon
longitudinal prominence at distal end of radius, 1/3 of the way across dorsum of wrist
stabilize one side, and move the other, feel for movement
ulnar deviate, in snuff box
on palmar side, bony tubercle, look at pic in book
Immediately proximal to thenar emminance, and distal to the snuffbox. Instruct pt to flex and extend thumb. Metacarpal head s
Towards the ulnar side of the trapezium. Heart shaped. In line with first digit.
go to lunate, move distally, in line with 3rd finger
sticks out during wrist flexion, disappears in wrist extension, in line with 3rd metacarpal
flat one on ulnar side
on palmar side, lateral and distal to pisiform (push down and in)
distal to ulnar styloid process, radially deviate so can move out from underm also lies under pisiform
palmar side, ulnar side, most prominent
between scaphoid, lunate and radius, find joint space
joint space between two rows of carpals
palm of hand
fingers
ulnar deviate and extend thumb, abductor pollicis longus & extensor pollicus brevis on radial side, extensor pollicus longus on
within anatomical snuff box
proximal to pisiform, just before the artery passes the ulna
deep to palmaris longus, defined by 4 palpable bony prominences: pisiform and tubercle of scaphoid, hook of hamate and tub
between hook of hamate and pisiform
in canal of guyon
runs over anatomical snuff box
at base of thumb, composed of abductor pollicus brevis, flexor pollicis brevis and opponens pollicis (deep)
proximal to little finger, extends longitudinally to pisiform, 3 muscles: abductor digiti minimi, opponens digiti, flexor digiti minimi
between metacarpals
Ulnarly deviate and extend the wrist. Palpable across the ulnar styloid to insertion of 5th metacarpal base.
slight indentation just radial to ulnar styloid process. Have pt place hand on table and raise little finger. (palpate higher than uln
Have pt place the hand on the table in a hex position (index and little fingers extended) ask pt to flex and extend the finger.
Extend the fingers and you can palpate the tendons inserting into the fingers. Palpate between carpal and MCP joints.
Ulnar border of the snuffbox. Ulnar deviate and extend hand.
Radial border of the snuffbox. Ulnar deviate and extend hand. More towards dorsal side
Radial border of the snuffbox. Ulnar deviate and extend hand. More towards palmar side
Flexion of IP joint
Stabilize distal phalanx of thumb and ask pt to flex thumb without flexing distal phalanx
moves DIP, hold others in extension
hold fingers in extension except finger being tested, flex finger in question at PIP joint
Flex and radially deviate the hand. Radial to palmaris longus tendon. Palmate proximally until it becomes indistinct beneath th
superficial layer of thenar eminence.
deep layer of the thenar eminance
Place your finger on radial side of 2nd metacarpal. Have pt flex MCP while extending Ips
Palpate between metacarpals as pt abducts fingers. Can only palpate 1st dorsal interossi between 1st and 2nd metacarpal
Part of hypothenar eminence. Have pt abduct little finger and palpate hypothenar eminence on ulnar side.
T1 is inferior to C7, does not move during rotation. T3 is the spines of the scapula. T7 is inferior border of scap. T12 is inferior
Go iliac crest and midline. Leaves you at L4-5 intersection. L1, just count down.
Fall off laterally. Use the thumb as a "dummy"
Ribs and transverse processes of the vertebrae.
Formed by the two PSIS and the gluteal cleft top.
Intersection of S2 spinous process
Above S2
Not palpable due to overhang of ilium and obstruction by supporting ligaments. Center of joint at S2 crossed by imaginary line
Position yourself behind pt. Put head back so that fascia relaxes. Not possible to differeniate, so palpate as unit on either side
Ilium to low ribs
Mastoid process to iliac crest
Spinous process to spinous process
Extend, rotates, and laterally bends. Palpate under the mastoid process.
used as accessory respiratory, largely inspiration, lateral from manubrium, ask pt to take breath, how much is rib cage expand
adjacent to sternum, take breath and forcefully exhale
put hands on stomach in supine and forcefuully exhale, xiphoid to pubic symphysis, against gravity is best
contralateral rotation side bend (R ext and L int work together)
ipsilateral rotation, iliac crest, hands in fan shape to feel, same sit up as external
hip hiker, 12th rib inferior margin to iliac crest, push erector spinae aside
get under abdominal muscles, hard in sitting, sausage, flex hip
ASIS to pubic tubercle, inferior margin of external oblique
stand in front of patient, place hands on ASIS …. should be prominent…OR…find belly button, go LAT and then move INF
find ASIS, move INF
find ASIS and move LAT
find ASIS and move LAT to midline of thorax
patient places their own hand onto their body and moves hand down toward pubic tubercle & pubic symphysis
patient places their own hand onto their body …. find greater trochanter, move along inguinal creases MED & obliquely downw
middle of buttock … sidelying with knee FLX … find greater trochanter, then PSIS then move INF to ischial tuberosity.
ASIS to iliac tubercle and move INF … IR/ER hip to feel it pop out
find ASIS and move MED … dig deep to palpate … resist hip FLX for "sausage to pop out"
find midpoint ischial tuberosity and greater trochanter
ABD leg away from midline … forms distinct ridge ... OR … think femoral triangle, then resist hip ADD
resist hip ABD in sidelying … SUP LAT portion of greater trochanter … palpate just below iliac crest & iliac tubercle
two-joint muscle … tighten quadriceps or resist knee EXT … OR … find AIIS for tendon attachment
sidelying … in between iliac tubercle and ASIS. … resist hip ABD (with possible hip FLX) to feel muscle belly
hip EXT & ER (straight or bent leg)
resist (FLX, ABD, ER) to make to make belly palpable
find patellar ligament … move LAT on either side into soft tissue depression Fall off of INF. Patellar pole and move lateral / m
fall off superior pole of patella and move med / lat to slightly in front of midline
FLX knee more than 90o and palpate MED to patella
FLX knee 90o and palpate LAT to patella in joint space
find MED femoral condyle … move Superior & POST (up the thigh) to distal end of femur … (between vastus medialis & ham
knee FLX … place fingers on MED & LAT joint lines and find patella … move upward toward depression
knee EXT … feel movement of patella
find LAT tibial tubercle and move LAT … OR … find patella, move INF to tibial tuberosity and move LAT
find joint line … find soft tissue depression … push INF to feel sharp upper edge of MED tibial plateau
find patellar ligament … move down INF until large bump can be felt on tibia
find tibial tuberosity, move LAT … attachment site for IT band … (do not confuse with head of fibula)
find LAT malleolus and move SUP…OR…find Gerdy's tubercle and go LAT
find LAT malleolus and move SUP
ANT portion of MED leg
obvious
draw line from MED malleolus to navicular tubercle & bisect that line….also INV & EV foot
deep to sinus tarsi
area where tibia articulates with talus … passively DF ankle and palpate between malleoli … PF & INV foot (palpate LAT side
joint found at the articulation of tibia & fibula (found proximal & distal)
also known as talocrural joint …. movement includes PF/DF …
eversion & PF … head & shaft of fibula … tendon can be found below fibular tubercle
eversion & PF … tendon can be found above fibular tubercle
able to see small portion of tendon
plantar flex foot, palpate upper portion of leg
flex knee and plantar flex foot…palpate either at lower 2/3 of leg or med/lat midline of leg below the gastrocnemius
dorsiflex your foot and palpate between tibia and fibula. The muscle belly lies in the middle to upper 1/3 of the leg
find tendon on POST MED malleolus … PF & INV
FLX of big toe … resistance at DIP
extend great toe, palpate at the base of the proximal phalanyx
flex toes and palpate at the base of each proximal phalanyx
extend toes, palpate at the distal portion of the metatarsals.
base of 5th metatarsal and move POST …OR... fibular tubercle and go ANT
find navicular tubercle and move dorsally
MED malleolus, go INF then ANT (about 2-finger's breadth away)
find navicular and INV / EV with slight PF
first cuneiform - articulates with base of 1st metatarsal - find navicular and move distal or find 1st metatarsal and move proxim
follow 1st metatarsal to its base…find navicular…cuneiform will be in between
in line with 2nd digit
in line with 3rd digit
head is most distal part of metatarsal … base is proximal portion of metatarsal
obvious
move along MED longitudinal arch & 1st metatarsal to plantar surface of MTP joint…EXT toe to make sesamoids more palpab
obvious
obvious
find LAT malleolus, go INFand slightly POST …OR…find fibular tubercle and go POST
ANT & POST tibiotalar, tibiocalcaneal, tibionavicular
find sustentaculum tali then find navicular tubercle…ligament can be found in between
on plantar surface, find fat pad, and go ANT … EXT toes to make aponeurosis more palpable
obvious
nst you while observing ribs 1-8 for contraction. Or, ask patient to push against a wall and look for scapular winging.
cles, not very distinct
s pollicis (deep)
opponens digiti, flexor digiti minimi
etacarpal base.
little finger. (palpate higher than ulnar styloid)
k pt to flex and extend the finger.
ween carpal and MCP joints.
us abdominus attaches
st gravity is best
tton, go LAT and then move INF
nd move LAT
or ER tibia to "pop" meniscus out (for MED meniscus)
le to fibular head
… PF & INV foot (palpate LAT side of talus) and talus should pop out … MED to LAT malleolus